To the Editor.
—Dr Nelson and colleagues1 report that in a multicenter study of almost 10 000 women across the United States, smokers showed a reliable loss of agility, strength, and integrative physical function even when such factors as age, history of stroke, body mass index, physical activity, and alcohol use were controlled. They go on to state that the physical performance deficit for an elderly smoker is roughly equivalent to the decline associated with an additional 5 years of age, and that amount of smoking is related to amount of performance decline. These last two observations indicate that the tobacco-related decline in physical performance is both clinically relevant and dose related.Although their data are important in their own right, their work takes on additional relevance when the question of tobacco's effects on performance is viewed globally. We know, for instance, that risk of vehicular accident (expressed as